December 2002 Bulletin

Fostering diversity important to continuing success of orthopaedics

Over the past year, diversity issues affecting orthopaedics and orthopaedists have been given a relatively high profile within the AAOS. This is most appropriate, as one of the 11 major goals in the AAOS Strategic Plan is to "foster diversity within orthopaedics and within the AAOS". While this goal has been in the Strategic Plan for the past several years, it was not an issue that received much of our attention.

Over the past several months, I have received a number of letters from many AAOS members. Most have been supportive of this push to increase the diversity of orthopaedics on all fronts. However, several letters have objected to what is perceived as my support for a quota system for orthopaedic residencies. My intent is not to lower the standards for those accepted into orthopaedic training programs but I strongly believe that qualification and diversification can and should co-exist.

In December 2001, the AAOS Board of Directors held a workshop to address the scope of diversity issues the AAOS faces. The product of this workshop was an action plan on diversity that included all components of AAOS. It became clear that these issues had a potential impact on all parts of AAOS and that horizontal integration was needed to allow for more effective implementation of the workshop recommendations. Each of the Councils has been charged with implementing at least some part of the diversity issues action plan.

To give you some idea of the breadth of the AAOS programs pertaining to diversity issues, I would like to review some of these projects for you.

Diversity in education

In the educational arena, one of the primary goals is to help orthopaedists improve their cultural competence in the daily care of patients from a wide variety of ethnic backgrounds. We have sought information from our international members and from minority orthopaedists in the U.S. on what effect ethnic customs may have on medical care.

Dissemination of this information is being done on the AAOS Web site, in the Bulletin (see the October 2002 issue), in CME courses, in self-assessment exams, and in the Annual Meeting symposia. Our attention to these ethnic customs and beliefs will improve our patients’ satisfaction and will likely improve the efficacy of the care we prescribe.

Diversity in communications

In the communications arena, the most visible project at this time is the inclusion on our patient education Web site, "Your Orthopaedic Connection," of more than 20 patient information articles written in Spanish on a variety of orthopaedic conditions. If you have Spanish-speaking patients, this resource will allow you to better inform them about their orthopaedic problems.

Other communications and public education projects include identifying "best practice" models related to ethnic issues and continued updating of the Web site on these issues.

Diversity in research

In the research area, the emphasis has been on identifying disparity of orthopaedic care and what to do about it. Attempts are being made to identify special needs of groups of patients who are currently underserved in the area of musculoskeletal health care.

Application has been submitted to the NIH for a research project on the disparity of orthopaedic care, particularly joint arthroplasty usage, among women and minorities. The principal investigator for this large grant request is James Wright, MD, MPH, and the AAOS is the principal institution supporting this application. In addition, we have submitted a proposal to the Agency for Healthcare Research and Quality (AHRQ) to sponsor a workshop in summer 2003 on diversity issues in musculoskeletal health care, and a possible NIH-AAOS workshop is being considered for 2004.

Diversity in health policy and practice

Linked with the projects in the research area are those in health policy and practice. Through the Washington office, we are advocating for funding for these research initiatives as well as for other aspects of culturally competent orthopaedic care. The Board of Councilors and the state orthopaedic societies have also taken on active advocacy roles for these issues on the local level.

While the other councils primarily are involved with public education and with improving the orthopaedist’s knowledge of cultural customs that impact our orthopaedic care, the Council on Academic Affairs is more involved with strategies to improve the diversity in the orthopaedic workforce.

The AAOS sent a booth to national medical student meetings this past year and we are attempting to increase the number of contacts orthopaedists have with medical students in the first two years of medical school. A new video on orthopaedics as a career has been completed. Mentoring programs have been established and are expanding to provide medical students a clearer view of the opportunities women and underrepresented minorities have in orthopaedics as a career.

Orthopaedic department chairs will play the key role in this effort because they need to personally support the recruitment of more diverse faculty and residency programs, while also putting a high priority on interacting with medical students at an earlier stage.

There are other projects as well. At the 2003 Annual Meeting, we will be presenting the first AAOS Diversity Award, to honor an individual who is a leader in this area. We are using more diverse spokespersons in our media and patient education material. The Leadership Fellows Program has a more diverse representation than the general AAOS membership. And, finally, the AAOS staff has enthusiastically supported these various diversity projects.

Why is diversity so important?

Why do I think this diversity issue is so important for orthopaedics? In the gender arena, the issue is clear. Over half of medical students are now female, yet less than 10% of our orthopaedic residents are female. There are actually fewer female orthopaedic faculty members in our university departments today than there were five years ago and there are no female orthopaedic chairpersons. This needs to change.

In the ethnic arena, the issue is similarly clear. Here in California, 26% of our 36 million residents were born outside the United States. Across the country, the Hispanic/Latino population is continuing to increase annually, not just in the border states. Immigration from many countries continues to increase. The need for cultural competence has never been greater and more important to our orthopaedic practices.

Until orthopaedics is able to attract more minority medical students into orthopaedic training programs, we will have to settle for better educating our members in the ethnic customs and beliefs that may impact their patients’ care. Better communication will improve our patients’ trust in the surgical and medical treatment we recommend and will improve the outcome of that care.

I ask for your on-going support for these and other efforts within the AAOS to address diversity issues. I personally believe these issues are extremely important for the continuing viability and success of orthopaedics and of the AAOS. I welcome any comments or suggestions you may have on this or other topics. I can be reached by e-mail at or by mail through the AAOS offices.

Vernon T. Tolo, MD

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